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Thomas Ruzicka, MD; Christa Sommerburg, MD; Otto Braun-Falco Dr he mult, MD; Wolfgang Köster, MD; Wilfried Lengen, MD; Wolfgang Lensing, MD; Heinz Letzel, MD; Wilhelm N. Meigel, MD; Eberhard Paul, MD; Bernhard Przybilla, MD; Markus Steinert, MD; Martin Winzer, MD; Arthur Wiskemann, MD

Arch Dermatol. 1990;126(4):482-486.

Abstract
• Compared with the antipsoriatic retinoid etretinate, the new aromatic retinoid acitretin represents an important advance due to its rapid elimination kinetics. Since in psoriasis vulgaris retinoids are used predominantly in combination regimens, we investigated the therapeutic efficacy of acitretin and UV-B compared with placebo and UV-B in a double-blind, randomized multicenter trial in 82 patients with severe psoriasis. They were treated with 35 mg of the study medication during the first 4 weeks of therapy and 25 mg thereafter, concomitantly with UV-B irradiation in increasing energy doses. Forty patients who underwent therapy with acitretin and UV-B and 38 patients who underwent therapy with placebo and UV-B were evaluated for efficacy. The target variables—psoriasis severity index and total UV-B dose—were reported at intervals of 2 weeks over a maximum period of 8 weeks. At the end of treatment, the psoriasis severity index decrease was 79% in the acitretin and UV-B group and 35% in the placebo and UV-B group. The response rate, defined as greater than or equal to a 75% decrease of the psoriasis severity index, was 60% for the combination treatment and only 24% for the control treatment. This treatment response was achieved with markedly lower cumulative UV-B energy. The median cumulative UV-B energy applied to reach 75% clinical improvement was 11.8 J/cm² vs 6.9 J/ cm². Side effects showed a similar pattern in both groups. Our data show that the acitretin dramatically improves the results of UV-B treatment in patients with severe psoriasis. In addition, it markedly decreases the effective cumulative UV-B dose, thereby reducing the potential long-term hazards of UV irradiation. We conclude that the acitretin plus UV-B combination treatment represents a highly effective therapeutic regimen in severe psoriasis.

(Arch Dermatol. 1990;126:482-486)

Author Affiliations
From the Department of Dermatology, University of Munich (West Germany) (Drs Ruzicka, Braun-Falco, and Przybilla); Staticon GmbH, Planegg (Drs Sommerburg and Letzel); Department of Dermatology, University of Hamburg (West Germany) (Drs Köster and Wiskemann); City Hospital St Georg, Hamburg (Drs Lengen and Meigel); Clinic of Dermatology, Medical School, Hannover (West Germany) (Dr Lensing); Department of Dermatology, University of Giesen (West Germany) (Dr Paul); Department of Dermatology, University of Tübingen (West Germany) (Dr Steinert); and Department of Dermatology and Venerology, Medical School, Lübeck (West Germany) (Dr Winzer).

Footnotes
Accepted for publication September 29, 1989.

Reprint requests to Department of Dermatology, University of Munich, Frauenlobstrasse 9-11, D-8000 Munich 2, West Germany (Dr Ruzicka).

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